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Accidental Logics

The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada

Carolyn Hughes Tuohy

What drives change in health care systems? Why do certain changes occur in some nations and not in others? Author Carolyn Hughes Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments, and in the distinctive "logics" of these systems. Tuohy looks at the experiences of Britain, Canada, and the US, offering an international comparative study of public policy systems, as well as a recent history of the circumstances in each country that have impacted on the structures of each's national health care system. The guiding focus of the book is Tuohy's study of decision making systems in each country, looking at the decisions made by those who provide, finance, and use health care services. Finally, Tuohy reviews current issues in the health care arenas of these three nations and provides suggestions to guide the strategic judgments that decision-makers must make.

Accidental Logics

The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada

Carolyn Hughes Tuohy

Description

Health care reform has become one of the most prevalent topics in recent policy discourse within and across nations. In the 1990s, common features of the health care arena elevated the importance of bargaining relationships among large, sophisticated entities as the dominant mode of decision-making, fundamentally challenging the traditional dominance of the medical profession, which had been grounded in individualized "agency" relationships between providers and patients. These developments have played out in varying ways around the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. What drives change in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments and in the distinctive "logics" of these systems. Her study carefully delineates both the common logic of the health care arena, deriving from micro-economic characteristics and technological change, and the particular logics of national systems, put in place by specific episodes of policy change. She goes on to explore how in the wake of these episodes, the mixed market in the United States, hierarchical corporatism in Britain, and the single-payer system in Canada determined the subsequent direction and pace of change in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that decision-makers must make within the health care system of each country. Accidental Logics uniquely departs from the descriptive literature currently available by presenting an extensive review of the evidence regarding the evolution of the health care arenas in the United States, Britain, and Canada, integrated within an explanatory framework. It is essential up-to-date reading for political scientists working in comparative politics and public policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs.

Accidental Logics

The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada

Carolyn Hughes Tuohy

Table of Contents

IntroductionCh. 1. Understanding the Dynamics of Change in the Health Care ArenaPart I: Episodes of Policy Change Ch. 2. The Establishment of the Welfare State in the Health Care ArenaCh. 3. The Reforms of the 1990sCh. 4. Ideas, Institutions, Interests, and Actors and the Accidents of Policy EpisodesPart II: The Distinctive Logics of National Systems Ch. 5. The US: The Logic of the Mixed MarketCh. 6. Britain: The Logic of Corporatism Meets the Internal MarketCh. 7. Canada: The Logic of the Single-Payer SystemCh. 8. ConclusionReferencesIndex

Accidental Logics

The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada

Carolyn Hughes Tuohy

Reviews and Awards

"Combining a mastery of empirical data and of theory, Professor Tuohy has produced the most sophisticated and illuminating account yet of how and why nations differ in their health policies. An indispensable read for health policy specialists, it is also an invaluable addition to the comparativist literature."--Rudolf Klein, Senior Associate, King's Fund, London

"Carolyn Tuohy's new book is splendid, the most significant scholarly work in comparative health politics and policy in the last two decades. Aiming to understand both change and continuity in American, Canadian, and British medical policy in the half-century after W.W.II, Tuohy manages both to do that and to make a theoretical contribution to the political analysis of public policy. No other recent work is of comparable scope and skill--a book, in short, worth reading by anyone seriously interested in politics, economics, and sociology of modern medical care."--Theodore R. Marmor, Professor of Public Policy & Management, Yale University

"Accidental Logics is a terrific book. Carolyn Tuohy makes the extraordinarily complex world of health care reform understandable even to non-experts, showing how past policy choices have caused three countries to address health care cost pressures in strikingly different ways. It is must reading for serious students of the welfare state."--Kent Weaver, Senior Fellow in Governmental Studies, The Brookings Institution

"An intellectually exciting book. An important theoretical contribution on path dependency in public policy, and a compelling reminder that different countries can and do chart distinctive approaches to heath care even in a global era."--Keith Banting, School of Policy Studies, Queen's University, Ontario

"The impressive book gives a detailed account of how different countries have responded to new but similar problems in the area of health care. It emphasizes the persistence of national traditions and the impact of decisions taken decades ago on current change, thus providing a clear and convincing application of the path dependency thesis. But it goes further than this by specifying the conditions that permit structural change in health care policy. In this respect, it marks a major step forward in our understanding of how health policy, and public policies in general, are made."--Ian Gough, Department of Social and Policy Sciences, University of Bath